Readmission and Adoption of Early Discharge After Colectomy Using ACS-NSQIP: Is It Time for Widespread Adoption?

• Published in: The Journal of surgical research Vol. 309; pp. 242 - 248
• Main Authors: Gaetani, Racquel S., Jonczyk, Michael M., Kleiman, David A., Kuhnen, Angela H., Marcello, Peter W., Saraidaridis, Julia T., Abelson, Jonathan S.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.05.2025
• Subjects: ACS NSQIP; Adult; Aged; Colectomy; Colectomy - adverse effects; Colectomy - statistics & numerical data; Colorectal; Early discharge; Elective colectomy; Elective Surgical Procedures - adverse effects; Elective Surgical Procedures - statistics & numerical data; Female; Humans; Length of stay; Length of Stay - statistics & numerical data; Male; Middle Aged; NSQIP; Patient Discharge - statistics & numerical data; Patient Readmission - statistics & numerical data; Postoperative Complications - epidemiology; Postoperative Complications - etiology; Propensity Score; Quality Improvement - statistics & numerical data; Readmission; Retrospective Studies; Time Factors; United States; United States; NSQIP; Colorectal; ACS NSQIP; Elective colectomy; Colectomy; Readmission; Early discharge; Length of stay
• ISSN: 0022-4804; 1095-8673; 1095-8673
• DOI: 10.1016/j.jss.2025.03.021

The timing of post-operative discharge following colectomy procedures remains a subject of debate among colorectal surgeons. Prior studies have demonstrated the safety and adoption of early discharge within 24 h after elective colectomy in carefully selected patients. This retrospective cohort study utilizing data from the American COllege of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) from 2012 to 2021. Adult patients undergoing elective partial colectomy with primary anastomosis and documented length of stay were included. Patients were stratified into early (< 24) and non early (≥24 h) discharge groups. Propensity score matching was used to control for baseline demographics and non-modifiable risk factors. Primary outcomes included 30-day readmission rates and adoption trends of early discharge over time. A total of 282,037 patients met inclusion criteria of which 6364 (2.3%) were discharged within 24 h. On propensity score matching the early discharge cohort had a statistically significantly lower rate of readmission (5.5% versus 7.3%, P < 0.001). Additionally, the early discharge group had a significantly reduced rate of anastomotic leak (1.0 versus 2.6%), ileus (2.0% versus 7.6%), and rate of reoperation (1.2% versus 4.0%) (P < 0.001). The proportion of early discharge colectomies increased from 0.8% in 2012 to 3.6% in 2021 (P < 0.001). In carefully selected patients, early discharge after colectomy with primary anastomosis does not increase the risk of readmission, reoperation, or 30-d complication rates. Furthermore, the increasing trend in utilization of early discharge after colectomy suggests an increasing acceptance of this practice, though it remains a minority of all colectomies performed among institutions participating in ACS-NSQIP.